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October 2010 - VISTAS


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									Also available on the chapter web site http://www.nmhfma.org/pb/wp_4f7a60f5/wp_4f7a60f5.h

      In This Issue
   President's Message

    Stat IQ Solutions -
     Platinum Annual

    Considerations for
  Acquiring or Affiliating
  With Another Hospital
      Welcome New
       Members               President's Message
   Medical Protective -      Fall in New Mexico is the most beautiful time of year, and I hope
    Platinum Annual
                             everyone has a chance to get outside and enjoy it. It can also be
                             an extremely busy time, and the ever-increasing demands on our
   UNM Health Sciences       time make it difficult to stay connected with the latest policy and
    Center Announces         regulation changes, as well as with our colleagues around the
   Vision for Year 2020      state. Your New Mexico HFMA chapter is working hard to give
    Collection Service       you timely, relevant information to provide value for your
    Bureau - Platinum        membership. Some of the chapter's recent educational offerings
     Annual Sponsor          have included:
      NMHA Update
                             · A seminar on Lean Six Sigma in healthcare.
  Training Available for     · Free webinars on revenue recovery management, inpatient medical necessity, and
  EMR Implementation         health care reform.
    and Management           · Sessions at the New Mexico Hospital Association on reducing medical necessity
    Moss Adams LLP -
                             denials, and regional and operational pricing effects and price defense.
    Platinum Annual
        Sponsor              I hope you will be able to join us for the upcoming events:
     Upcoming Events         · Annual Conference: Shaping the Future of Healthcare - November 11-12, 2010
     Revenue Cycle           · Free HFMA Virtual Healthcare Finance Conference - December 1-2, 2010
     Outsourcing -
      Transparent            In addition, many of you may have already received a survey from HFMA National to
    Measurement and          determine how well the New Mexico chapter is meeting your needs. As you can see
        Control              from the above educational offerings and our 2010/2011 strategic plan, chapter
  Changes to the CHFP        leaders have been doing their best to provide members with maximum value for their
  Certification Program      membership.
  REDW The Rogoff Firm       You spoke in last year's survey and we listened.
    - Platinum Annual
                             If you have received the survey, please take the time to reply and let us know that you
   A Message from our        appreciate all that we are doing to deliver the best quality education and value by
   Regional Executive        marking the survey VERY SATISFIED OR EXTREMELY SATISFIED. This survey
    Call for Input and
                             means a lot to us and we would appreciate your feedback. If there is something that
      Participation          you feel we are not doing, we want to know about it. Please email me directly at
    2010-2011 First
  Quarter P&L Summary        Wishing you the best this fall and during the upcoming holiday season.
     NM              Chris Tyhurst
HFMA Offers
  Free Job           Stat IQ Solutions - Platinum Annual Sponsor
Postings to its

 Classified Ads

 Officers and
   Board of

 Christopher W.

President Elect;
 Steven R. Figge     Considerations for Acquiring or Affiliating With Another
Vice President;      The economic downturn and resulting restricted access to capital have caused many
Program Chair        hospitals to consider a partner or other affiliation strategy. Declining volumes and the
  Bridgette M.       deteriorating payer mix, a result of high unemployment rates, are further forcing these
     Garcia          discussions - as are the seemingly countless opportunities for capital rich hospitals to
                     acquire struggling, undervalued hospitals.
  Secretary;         Recent healthcare reforms signed into law may have a further impact on hospital
  Newsletter         affiliation. In fact, a recent Moody's report predicts that "as governmental auditing and
    Chair            oversight of revenue are tightened, hospitals will be pressured to operate more
  Mike Nelson        efficiently, forcing spending cuts and mergers among smaller hospitals after 2014." In
                     layman's terms: as reform legislation reduces Medicare reimbursement and
                     disproportionate share funding, and with higher costs, less efficient hospitals could see
   Treasurer         further Medicare reductions under the law's efficiency provisions.
Joshua F. Trujillo
                     Affiliating or acquiring may be the right thing to do, but before taking such a step, there
Past President;      are some considerations for both parties. From the perspective of the facility that
                     needs a partner to survive in the long term, the executive team and board of directors
 Membership          need to carefully consider the type of affiliation needed (i.e. what objectives need to be
     Chair           achieved through the affiliation) and the type of partner needed.
  Renee Ennis
                     From the perspective of the hospital needing a partner, there is a continuum of control
                     that the board wants to consider (i.e. How much control and independence do they
                     want or have the ability to retain?). At one end of the spectrum is an affiliation
                     arrangement that simply calls for cooperation between the hospitals for some mutual
  Directors          benefit and virtually all control is maintained. At the other end of the spectrum is an
Marianne Bjelke      acquisition of one facility by the other and all control is surrendered to the acquiring
                     facility. In between are management agreements, clinical affiliations, lease
                     transactions, and more formal partnerships with legal and financial commitments by
Bradley B. Cook      each party.
Julie C. Nickerson   Consideration should also be given to the benefits provided by the other party. For

 Linda L. Novy       · If capital needs are driving the decision, then the strength of the balance sheet of the
                     acquiring facility should be evaluated. Will they be able to provide the capital needed
  Robert C. Tyk      for the coming years?
                     · If expanding the hospital's market is the objective, will the partner provide the
                     complementary service lines, the brand name and reputation that will enhance the
                     ability to increase market share?
  ANNUAL             Another consideration is whether the acquiring hospital or system has had experience
 SPONSORS            with successfully acquiring other facilities. The merging of two cultures and achieving
                     the synergies planned are not always easy or successful. Those facilities with a
   Platinum          successful track record of achieving these objectives are more likely to be successful
                     again. Does the acquiring facility have the management staff depth to assume the
  Collection         assimilation of another hospital into the organization's structure?
                     Does the acquiring facility have the ability to recruit physicians in a different way? If so
 Bureau Inc.         they may be able to bring physicians who can facilitate strategic growth initiatives.

   Medical           Achieving synergies through elimination of duplicate services and departments seems
                     rather simple on paper, but are often met with failure due to poor execution or cultural
  Protective         conflicts. Do not underestimate the cultural differences between two organizations that
                     come together.
Moss Adams           And what are the capital needs of the acquiring facility? Are they capital starved? If so
   LLP               they won't have the capital to fund your capital needs either.

                     Debt Factors
 REDW The            Most debt structures have broad provisions for mergers and acquisitions, and they
Rogoff Firm          often require bondholder or lender approval prior to such a transaction. Reviewing the
                     debt documentation is a key first step in proceeding with any affiliation/merger
   Stat IQ
                     Hospitals must understand what corporate entity is obligated in the outstanding debt o
  Solutions          the hospital being brought in, usually known as the Obligated Group. For example, a
                     debt obligation may be supported by both a hospital and its physician practice group -
  United-            two separate entities. The merger/affiliation, however, may be desired with the hospita
                     only. Understanding the assets or collateral the hospital owns and the debt it can
 Healthcare          support without the physician practice group is important to knowing how it might be
                     able to refinance or restructure existing debt. In addition, the acquiring hospital/system
                     may have limitations on its ability to restructure its Obligated Group and must
      Gold           understand current refinancing limitations on its own debt before proceeding with the
    Clinical         merger/affiliation.
Colleagues, Inc.
                     My Debt is Your Debt
 Creditwatch         A hospital with outstanding letter-of-credit-enhanced debt may see its debt structure
                     improved by affiliating with a partner that brings a stronger financial position or
   Services          banking relationship to the table. The LOC may be able to remain in place, saving both
                     hospitals the time and cost of refinancing. Further benefits can be realized if the
 Professional        acquirer has a significant banking relationship with the letter of credit provider, which
   Finance           may prove cost beneficial.
  Company            HUD/FHA Section 242 mortgage-insured loans are assumable by acquiring hospitals,
                     with approval from FHA, and they remain non-recourse to the affiliation/ acquiring
The SSI Group,       hospital. It is important to understand the limitations of transfers among affiliated
     Inc.            entities when assuming such a financing structure, but the current limitations on
                     transfers are not overly burdensome and should not be viewed as a deterrent to the
                     affiliation/merger. FHA-insured loans can be assumed by either nonprofit or for profit
 Commerce Bank       USDA direct loans may be assumable depending on the acquirer or affiliation partner.
                     USDA financing is limited to nonprofit hospitals that are rural and that cannot access
   Menicucci         other means of capital. If an affiliation changes any of these features, then the USDA
Insurance Agency     financing would most likely have to be refinanced. If the partner is a similar-sized rura
                     nonprofit, then assuming the debt may be negotiable.
   NHI Billing
    Services         If a hospital is considering a new debt instrument and is also considering a future
                     affiliation/merger, it should proactively consider future flexibility in creating its financing
Synergy Consulting   documents. Potential negative implications of a merger/affiliation can be minimized or
  Associates, Inc.   eliminated through active management of debt covenants and prepayment
                     requirements within the financing documentation.
TriCore Reference
   Laboratories      Lastly, as organizations consider a merger/affiliation, they need to evaluate the
                     impacts of such a transaction on the investment portfolios of each as well as any
                     interest rate mitigation contracts such as swaps, caps or collars on the new combined
Plan to Attend       entities. Often these contracts will also include provisions related to
                     mergers/affiliations, which may impact the ultimate decision and/or timing of the
                     transaction. A comprehensive balance sheet analysis needs to occur along with the
November 11-12       evaluation of the debt instruments of both parties.

  Shaping the        Mike Johns, QHR and Tanya Hahn
   Future of
                     Reprinted with permission from Lancaster Pollard's 'The Capital Issue' at
  Healthcare         www.lancasterpollard.com.

                     Welcome New Members
                     We would like to welcome all those who have recently joined our Chapter

                                                           New Members

                         • Theresa R. Alires, Manager of Specialty Services
                           Presbyterian Healthcare Services

                         • Leslie C. Armijo, Manager of Hospital Insurance Collections
                           Presbyterain Healthcare Services

                         • Natasha Katko, Decision Support Analyst I
                           Christus St. Vincent Regional Medical Center

                         • Alicia Montoya, Manager, Cash Applications
                           Presbyterian Healthcare Services

                         • Evelyn Moore, Third Party Billing Manager
                           Presbyterian Healthcare Services

                         • Margaret R. Phoenix, Director of Revenue and Billing
                           Christus St. Vincent Regional Medical Center

                         • Natasha Wampach, Manager
                           Triage Consulting Group

                     Medical Protective - Platinum Annual Sponsor
UNM Health Sciences Center Announces Vision for Year 2020
On September 15, the University of New Mexico Health Sciences Center released the
following statement of its vision for 2020:

The University of New Mexico Health Sciences Center (UNM HSC) is a public
academic health center which is committed to implementing the major aspects of the
Patient Protection and Affordability Care Act, whether or not the institution receives
funding for each section of the Act. UNM HSC offers a model for other public and
private academic health centers. It is the nation's first to set as its measure of its
success, the health of its state populations. Called, "Vision 2020," it states, "UNM
HSC will work with community partners to help New Mexico make more progress in
health and health equity than any other state by 2020"

To fulfill this vision, all colleges, schools, departments and programs at UNM HSC
have incorporated into their annual performance plans how their education, service
and research enterprises will measurably improve the health of New Mexico.
On the afternoon of Wednesday, September 15, 2010, the entire UNM HSC, its
students, faculty and staff, participated in the Vision 2020 Symposium. The intent was
to introduce Vision 2020 to the institution, to the communities, to state agencies and to
state and national legislators, and to learn from each other - from hundreds of posters,
presentations and exhibits illustrating the range of interventions existing and planned,
to exploring how we can be more effective in improving the health of New Mexico's
communities, to learning how these efforts are relevant to health care reform and to
county-by-county health indicators.

It is intended that this approach will serve as a model for institutions nationally.
UNM HSC is poised to assume a national leadership role in making "community
health" the central vision and mission of all academic health centers. This vision is
built on a series of important initiatives the institution has initiated in New Mexico
which have been emulated by others and have had national implications:

· New Mexico is the only state with a 24/7 statewide Nurse Advice Line free to all
callers and successful in significantly reducing unnecessary ER visits
· It is the state which created the Health Extension Rural Offices (HEROs) program,
created on the agricultural Cooperative Extension and the model used by
Congressional staff to develop Section 5405 of the PPACA- "Primary Care Extension
· It has extended the concept of the Patient-Centered Medical Home in address
community health through its "Health Commons" models of care in rural and urban
· It is the smallest and perhaps the most rural state to receive a Clinical Translational
Science Center award from NIH and to disseminate its strategies to larger institutions
receiving the award
· It has the first medical school in which all medical students will graduate with a Public
Health Certificate
· It is one of the leading minority-serving institutions which has created BA/MD,
BA/PharmD, and BA/DDS programs into which rural and underrepresented minority
students predominate
· It was recently the recipient of the AAMC's Spencer Foreman Award as the leading
academic health center in Community Service.

Contact Cindy Foster at (505) 272-3322 for more information.

Collection Service Bureau - Platinum Annual Sponsor

NMHA Update
Every September, the New Mexico Hospital Association holds is annual meeting. And
once again, the New Mexico HMFA chapter participated in that meeting by hosting two
interesting educational sessions. On the morning of September 16, Jamie Cleverly, of
Cleverly and Associates, presented information on influences on hospital pricing
practices and strategies for defensible pricing policies. He compared pricing levels for
a variety of hospital settings and structures, including for-profit vs non-profit, small vs
large and rural vs urban. He described three methods that can be used to defend
hospital pricing: an ROI model, peer comparison and cost mark-up. The presentation
offered a host of valuable information and we appreciate Jamie's support of the

 Jamie Cleverly of Cleverly & Associates and Brad Cook, a NMHFMA Board member

Following Mr. Cleverly, Rik Lewis from Moss Adams described the RAC Attack! The
Recovery Audit Contractors' audits are in full swing across the nation. Rik's
presentation highlighted the importance of focusing on documentation of Medical
necessity. Indeed, 62% of take backs resulting from the audits, in terms of dollars, are
related to failure to adequately document medical necessity of higher-coded services.
And over one billion dollars have been recovered so far. Check out Rik's slides on the
NMHFMA website for more details.

         NMHFMA President-Elect, Steve Figge with Moss Adams' Rik Lewis
                       and Past President Renee Ennis

The afternoon at the annual meeting included a presentation on the implementation of
the healthcare reform bill by AHA Executive VP, Rick Pollack, a discussion of restoring
public trust in the health care system by Ross Goldberg and a light-hearted wrap-up
by the "Healthy Humorist," Brad Nieder, MD. It was a very good conference and we
appreciate the opportunity for the NM chapter to be a part of it.

Training Available for EMR Implementation and Management
The HITECH Workforce Program at Midland College is designed to cross-train
professionals with a background in HIT or IT and prepare them for the federal initiative
of Electronic Health Records implementation. Midland College is designated as New
Mexico's trainer for these programs. Training is available for six workforce roles,
depending on the student's interests and background. According to the Office of the
National Coordinator, estimated salaries for employees in these roles range from
$44,000 to $126,000. The training for each role can be completed in six months or
less and all courses are self-paced and on-line. The cost for the training for each role
is $400; however, when successfully completed in six months, a 100% stipend
reimbursement is available. This Midland College HIT program is accredited through
the Commission on Accreditation for Health Informatics and Information Management
Education (CAHIIM) and the six certificates are approved by the New Mexico
Workforce Investment Act. For more details, visit www.midland.edu/hitt.

Moss Adams LLP - Platinum Annual Sponsor

Upcoming Events
There's still time to register for the NM HFMA's fall conference! On November 11 and
12 at the Hyatt Regency Albuquerque, the chapter will present sessions on the latest
in the NM Medicaid program, 340B drug pricing, getting the best out of your talented
employees, and healthcare reform. There will also be concurrent sessions on 10
control items to score and manage in the professional practice, a rural healthcare
roundtable, the changing accounting and financial reporting landscape and an
oncology update. UnitedHealthcare, Humana and Blue Cross Blue Shield will
participate in a payor roundtable and Presbyterian Healthcare Services CEO, Jim
Hinton will present the keynote address. We hope to see you there!

Revenue Cycle Outsourcing - Transparent Measurement and
Healthcare Reform will continue to drive the outsourcing of revenue cycle processes to
companies that specialize in key aspects of the process. It's no secret that the
healthcare revenue cycle is complex and attempting to be a "Jack of all Trades" is why
providers currently struggle to align their internal efficiencies. It is simply too much to
ask of most organizations to maximize the process from beginning to end on their
own. Outsource partners who specialize in key aspects of the revenue cycle can and
will do certain things better but providers need to have the tools to manage that

Many providers understandably worry about a loss of control when outsourcing a
portion of their revenue cycle and that is why best practices dictate a transparent flow
of communication and business intelligence from the partner to the provider
throughout the process.

Let's consider self pay active receivables outsourcing. Providers should insist on real
time access to A/R inventory data that includes: placements, recoveries, close and
returns, and inventory by aging bucket or status. Providers should be able to drill
down from top level detail to individual accounts for auditing purposes. In other words
the information flow should be transparent and as accessible from 10,000 feet as from
the ground.
Provider management may want to review a slice of their Active A/R by aging bucket,
and maybe even the accounts by status that make up that bucket. A drill down on any
bucket will show you that. Further drill downs will get you to a listing of accounts that
make up that status class while a final drill down will take you to any individual
accounts for an account level audit. This is 10,000 to the ground in 4 hyperlinks and
what you should expect in order to measure and manage your receivables.

Measuring the work efforts of your outsourcing partner's statements and phone calls
seems to be a constant source of concern for many providers. Providers should insist
that this information be accessible at any time, for any time period of interest to their
organization. A drill down takes you to the detail of that activity, such as answering
machines, no answer, payments, etc.

This is just a brief overview of some of the best practices tools that should be utilized
when measuring and managing an outsourcing partnership. High quality companies
will make these kinds of online tools available as part of their services and can be
used as an informal litmus test of the expertise of any outsourcing provider you may
be considering. In short, knowing what your partner is doing should never be a
mystery; it should be obvious, transparent and available whenever it is convenient for

Reprinted with permission from Collection Service Bureau, Inc.
(www.csbcollections.com). For more information, contact Chris Becraft, President of
CSB at chris@csbcollections.com

Changes to the CHFP Certification Program
In an effort to ensure HFMA meets the needs of currently certified members or those
considering certification, and to increase CHFP's recognition in the industry, an
extensive field study was conducted. The findings of the study indicated that members
were seeking financial management education that is comprehensive, cross-
functional, and integrated. The findings of the study also indicated that the certification
program should provide easier access to both preparation materials and
examinations. HFMA's Board of Examiners employed these findings as the guiding
principals in restructuring the program.

Effective January 2011, the certification requirements are as follows:
· Successful completion of one comprehensive certification examination designed for
mid-level healthcare finance professionals (currently two examinations are required)
· Current HFMA membership (currently a minimum of 2 years of membership is
· Study/preparation materials available online (currently available in hard copy only)

We are certain that these changes will provide candidates fewer barriers and a more
seamless process in their path to certification. For more information download the
certification FAQ document and learn more about the CHFP certification at
http://www.hfma.org/certification. For those members who are currently certified,
please note that there are no changes to the certification maintenance plan.

Interested in Becoming Certified?

Email the certification office at certification@hfma.org with your name, phone number,
and email (please confirm the best email address to reach you regarding this matter).
You will be contacted in January to answer your questions or guide you through the
registration process.

REDW The Rogoff Firm - Platinum Annual Sponsor
A Message from our Regional Executive
Unity and Commitment
One thing I saw at our Fall President's Meeting in Hawaii August 29th & 30th was that
Region 10 is blessed with a great group of chapter leaders. Each have a very strong
commitment to their chapter's success. They are very knowledgeable and determined
to achieve the high standards set by HFMA National. Couple these with being
creative and the ability to think outside the box and I am very proud of the opportunity
to serve as their Regional Executive this year.

I have had the opportunity to attend four Fall President's Meetings and in the past it
always seemed that the individual chapter leaders where always looking out for
number one and if another chapter had any type of problem, let them figure it out
themselves. While we do have our own chapters to lead, we are also part of REGION
TEN and my goal this year is to try to bring a stronger sense of unity to the region. At
the FPM this year we tried something new, a group exercise splitting up in groups of
three, that is three from different chapters so people became better acquainted with
each other. We also encouraged comments, suggestions and praise during the
meeting discussions. It was good to see the interaction take place and the different
ideas come up as we discussed agenda items. I feel we acted more like a team of
leaders rather than a group of individuals thinking only of themselves and their

Commitment is another part of the success factor. I have always felt that if a group, in
this case a chapter, selects you as their president and you accept you owe them your
commitment 100%. This means to become as knowledgeable as you can of what the
position requires and take advantage of learning sessions available to make your roll
easier and successful. Commitment can only come from you and for many of us it
comes very easily. Through pride and ownership and a little competitive spirit, we only
want to do our best. In Region Ten I found all chapter leaders have these qualities
and it is truly a great feeling to see the winners in each one of them.

I have had the opportunity to attend two chapter board meetings in our region. I see
the same spirit, the same commitment in the board members of each. As you look at
your chapter leaders I believe you will also see this commitment but at the same time
how willing they are to help others in need. It's called unity. As a team we can
accomplish anything. Yes, it takes a little organization too but that comes with the
knowledge we've received in the past from HFMA.

We truly have a good group of chapters in Region Ten which make a great Region.
Thank you for letting me serve as your Regional Executive this year.
Pictured is our group from the Fall President's Meeting in Lihue, Kauai, Hawaii.

Dave Chohon

Call for Input and Participation
The Newsletter Committee for the NM Chapter of HFMA invites you to provide your
input and feedback on what you like about the newsletter and what you'd like to see
changed. Are there topics about which you'd like to see articles? Are you aware of
members or health care organizations in New Mexico that deserve recognition? We'd
love to hear about them! We also welcome your participation in chapter activities - if
you are interested in helping out with the quarterly newsletter or other chapter
activities, please let us know. You can e-mail us at: nmhfma@scltd.biz.

2010/2011 First Quarter P&L Summary
                      *Budget numbers are annual; YTD numbers are actual for the first quarter of the
                      chapter fiscal year

                                             New Mexico Chapter of HFMA
                                                   P.O. Box 9723
                                               Albuquerque, NM 87119

                                                 email: nmhfma@scltd.biz

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